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N.H. fire departments expanding roles

Joanne Woodward’s doctor doesn’t like her blood pressure levels. So when Hopkinton Fire and EMS comes to the Slusser Senior Center to do blood pressure checks, Woodward gets in line. “It relieves my mind that it is in the right range,” she said.

The checks are one of many community health services the Hopkinton Fire Department provides. The fire station serves as a walk-in medical center, where residents can get blood sugar checks, dressing changes and advice on whether they should go to the hospital.

This year, the town approved an expansion of the Contoocook Fire Station that will increase space and resources for community health care.

“Walk-in medical care in the stations is becoming more prevalent,” said Hopkinton fire Chief Doug Mumford.

Calls for EMS are out-pacing fire calls at many New Hampshire stations and the departments are taking on a larger role in community health. “For a number of years, we have seen ourselves as the safety net of public health,” said Goffstown fire Chief Richard O’Brien.

Now there is a push to formally expand the role of emergency services in health care, and the change could take shape in the state over the next few years. Called “mobile integrated health,” the goal is for EMS to fill the gaps in the health care system. Instead of being based mainly around patient transport, emergency medical services could expand to include making home visits, running prevention programs or coordinating referrals.

“A lot of patients we take don’t want to go to the hospital, but don’t know who else to call,” said Nick Mercuri, chief of the state’s Bureau of Emergency Medical Services. “We can save the system money by providing services and working collaboratively with everybody – hospitals, VNA, home care services. . . . We want to take care of patients not taken care of under the current system.”

More choices

The movement toward mobile integrated health stems from a desire to coordinate care more efficiently and increase access and choices for patients, especially as new health care regulations roll out. Right now, access to urgent, preventive, or primary care is limited or difficult to afford for a significant number of people across the country and in rural areas, including parts of New Hampshire, said Dr. Tom Trimarco, EMS medical director for Dartmouth-Hitchcock Medical Center.

“Within the fire service/EMS community we have well-trained, well-educated people,” he said. “People recognize we have this great resource in our community.”

Under the new program model, EMS could, for example, help patients transition from the hospital more smoothly by doing home visits, checking patients’ medications, bandages or weight, and coordinating with their primary care physicians or the VNA, said Dr. David Hirsch, EMS medical director at Concord Hospital.

It would mean using the existing EMS system, but in a different way and in collaboration with the other services already available.

“The goal is to catch patients before they get too sick and prevent unnecessary ER visits,” Hirsch said. Under the Affordable Care Act, hospitals can now be penalized for patients who seek readmission in a 30-day time period for certain diagnoses. “Hospitalization is costly for patients and the system.”

Mobile health care programs already exist in several states, including Maine and Texas. New Hampshire doesn’t have an operating program yet. But the state did open the door in 2013, when mobile integrated health protocols were added to the state EMS guidelines. “This gave us the opportunity to explore the possibility,” Mercuri said.

‘A lot of potential here’

Concord Hospital is in the very preliminary stages of setting up a pilot program with the Concord and Hopkinton fire departments. There is no planned start date, but the groups have begun research and discussion. “It has a lot of potential here, based on the system we work in,” Hirsch said.

Many fire and EMS departments are already well-poised to do this, experts said, because they are integrated into the community and have the training.

In some cases, EMS personnel responding to 911 calls may pick up on public health trends that other officials wouldn’t notice, O’Brien said. At his old station, he said, responders recognized an uptick in elderly people slipping and falling in their homes. In response, the department partnered with the American Red Cross to run a prevention program.

“There is really no other health care provider in the system that tends to see patients where they live, work, their environment day-in and day-out,” Trimarco said. “Without being able to look inside a patient’s home . . . a lot can be overlooked and missed.”

Like the Hopkinton Fire Department, many stations have already taken on a role in community health as duties of fire departments have evolved. It used to be, put out fires, said O’Brien, who also represents the New Hampshire Association of Fire Chiefs on the state EMS coordinating board.

Today there are not as many fires, in part because of a successful fire prevention program initiated in the 1980s. “Now we have become this all-hazard response system,” he said. “It’s the same thing with medical emergencies; people tend to rely on 911 services.”

In Goffstown, 60 percent of calls are medically related, O’Brien said. In Concord, it’s two-thirds of the calls, said fire Chief Dan Andrus. For Hopkinton, it’s about 75 percent, Mumford said.

“We have the facilities and the man power and resources to take on this role,” O’Brien said.

Resources question unclear

If the role expands, the question of cost and resources becomes more fuzzy. Within the current guidelines, fire/EMS departments are reimbursed when they bring a patient to the hospital, but receive no payment if they treat and assist someone on site, Hirsch said.

Under an expansion, the preventive services EMS provides might be paid for by insurance or the supporting hospital. Depending on each station, a department may need to bulk up on resources, personnel or training. It’s still too early in the process to know where the money will come from, Mercuri said.

“We’re seeing a paradigm shift within EMS to have an opportunity to be much more part of the health care system and really show our value versus just transportation to a hospital.”

(Allie Morris can be reached at 369-3307 or at amorris@cmonitor.com.)

the first time a town gets sued because some EMT makes a mistake should end this. another bad idea IMHO

The focus of this article is about fire/ems departments and better patient care. In reality, hospitals are driving this because insurance regulations shortly will stop paying hospitals for patient re-admissions. So this is not about patient care, although there may be some patient benefit, it is about hospitals continuing to get their money as the healthcare laws change.

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